To Retrospectively Evaluate The Reliability And Validity Of The Subaxial Cervical AO Spine Injury Score And Its Influence On The Treatment Decision Of Subaxial Cervical Spine Injury

The Subaxial Cervical Injury Classification(SLIC)and AOSpine subaxial cervical spine injury classification system(AO Spine SCICS)are currently the preferred classification systems for the classification of subaxial cervical spine injuries and for obtaining treatment advice.The Subaxial Cervical AO Spine Injury Score(Subaxial AOSIS)is a scoring system based on AO Spine SCICS.Objective: To evaluate the reliability and validity of the Subaxial AOSIS,and assign treatment options according to the threshold of Subaxial AOSIS score.To evaluate and compare the reliability and effectiveness of SLIC score and Subaxial AOSIS score in guiding the treatment of subaxial cervical spine injury.Methods: 156 patients with subaxial cervical spine injury were retrospectively analyzed.Subaxial AOSIS scores were performed by three doctors twice before and after.Kappa coefficient and intraclass correlation coefficient(ICC)were used to analyze intra-observer repeatability and inter-observer reliability.Based on the distribution of Subaxial AOSIS scores in surgical and conservative patients,the thresholds for assigning treatment options to Subaxial AOSIS scores were obtained.To evaluate the reliability and effectiveness of Subaxial AOSIS and SLIC systems.Results:1.In the Subaxial AOSIS scoring system,the intra-observer mean Kappa values were 0.663,0.661,0.783 and 0.581 in the four subgroups of subaxial cervical spine injury morphology,facet joint injury,neurological status and case-specific modifier,respectively,and the inter-observer mean ICC values were 0.909±0.01,0.888±0.03,0.943±0.02 and 0.684±0.06,respectively.The intra-observer Kappa values of total score of Subaxial AOSIS scoring system were 0.416,0.415,and 0.436,respectively,and the inter-observer mean ICC value was 0.932±0.01.2.The resulting Subaxial AOSIS scores assigned treatment options with thresholds of 5,6,and 7.The Kappa values of the three doctors ’treatment opinions were 0.614,0.582,and 0.733,respectively,using Subaxial AOSIS scoring system.Inter-observer reliability was evaluated using ICC,which was 0.856 and 0.864 for the first and second scores of the three physicians,respectively.The ICC value between the three physicians who first used the SLIC system was 0.921.Conclusion: 1.The four subgroups of Subaxial AOSIS have good reliability and validity except for the case-specific modifiers.The reliability and validity of the total score of the Subaxial AOSIS scoring system were general.2.This study concluded that the Subaxial AOSIS treatments for scoring system:score less than 5 points suggested that conservative treatment;Score is equal to 5,6,or 7cents suggestion can be conservative treatment can be surgical treatment;Score more than seven points suggested that surgical treatment3.The Subaxial AOSIS scoring system has good reliability and validity in treatment selection,and the inter-observer reliability is slightly lower than that of the SLIC system.